filling the day with meaning - orh · 2 days ago · oregon’s older adult behavioral health...

Filling the Day with Meaning

Rod Harwood, MDiv, MA, QMHP-C , Greater Oregon Behavioral Inc.

• Audio and video are muted for all participants.

• By selecting the Q & A and Chat features will populate to your right. Please ask questions using the Q&A featured and use the chat function for everything else.

• Our moderator will read questions to the speakers at the end.

• Presentation slides will be posted at: https://www.ohsu.edu/oregon-office-of-rural-health/forum-aging-rural-oregon, and recordings will be posted shortly after the session.

https://www.ohsu.edu/oregon-office-of-rural-health/forum-aging-rural-oregon

Oregon’s Older Adult Behavioral Health Initiative (OABHI)Why: Older adults and persons with disabilities face unique barriers to having

their needs met.What: We are here to help improve the quality of life and systems of care for

older adults and people with disabilities.Who: 24 specialists that work throughout Oregon’s 36 counties serving older

adults in gaining better access to necessary behavioral health services.How: Specialist conduct community education, workforce development

trainings and complex consultations. We help engage and encouragecollaboration with other agencies to improve outcomes for older adults.

For more info visit:gobhi.org/programs/oabhi & oregonbhi.org

Filling the Day with Meaning

Description: This training explores how factors such as spiritual wellness, personality style, health and usual daily routine have a role in building and maintaining meaning, relationship and hope for older adults in the midst of Covid-19.

Objectives• Understand how changes imposed by the epidemic impact spiritual, emotional and physical health

• Learn how to use the Spiritual Health Assessment to understand the basic needs of the human spirit

• Build a framework for providing a person centered balance of activities that fill the day with meaning for each older adult

Challenges to Older Adults Wellbeing

Engagement and PurposeFinancial Wellness

Mobility and Movement

Daily Living and Lifestyle

CaregivingCare Coordination Brain Health

End of Life Transportation

Time Use – Typical Older Adult 24 Day

Household Activities 2 hrs

Sleep 9hours

Leisure & Sports7 hrs

Work related activities1 hrs

5 hrs ?

Challenges in a quarantineLiving in a Pandemic

Impact of Quarantine• They found a high prevalence of psychological distress

symptoms. • 29% post-traumatic stress • 31% depression • Participants in this study described a sense of isolation

and were particularly affected by the lack of social and physical contact with family members.

How to Manage the Psychological Effects of Quarantine, Phycology Today, Mark Banschick M.D., March 20, 2020

Normal Functions o Primitive BrainThe Primitive Brain takes care of the autonomic body functions

– The Heart If it notices you are more active, it gets more active. If you slow down, it slows down.

- Notices you are getting low on fuel Signals that you are hungry or thirsty

- Movement from space to space signals (cues) certain activities

Primitive Brain

Routine

Transition

LIFEROUTINE

Routine

Rhythm

Experiencing a Loss of Daily RoutinePrimitive Brain is having a hard time

Routine

Ø Forcing it to work harder

Ø Disruption of routine throwing it off balance

Signs of Older Adults not coping well• Changes in routine

– Isolation (Hide) and lack of interest in socializing

– Hyper socialization (seek) – demand greater attention

• Losing track of dates and times

• Memory and cognition problems

• Going through prescriptions more quickly

Time Use – A Balance of Meaningful Activities

ProductiveRestorative

LeisureSelf Care

24 hr. Day

A HEALTHY OLDER ADULT

• Physical — Medical = PAIN FREE

• Emotional — Social = SUPPORTIVE

• Spiritual — ‘Anamcara’ = PEACEFUL

Religion & Spirituality

Religion is the container in which the life of the spirit grows

Basic Needs of the Human Spirit

Healing through Self Awareness

“ I set before you today life and prosperity,death and destruction …

“Choose Life!”

Healing through Self Awareness

sacredartofliving.org

Richard & Mary GrovesSacred Art of Living Center was established in 1996 by Richardand Mary Groves in Bend, Oregon, as a first-of- its-kind non-profiteducational institute providing workshops and professionaldevelopment focused on whole person caregiving.

www.sacredartofliving.org © 2010 Sacred Art of LivingCenter for Spiritual Formation

MEDICAL MODEL

PAIN

SUFFERING

Responsive to interventions of the medical model

Unresponsive to interventions of the medical model

SUFFERINGSuffering occurs when we assign meaning to the experience of physical or emotional pain… ORWhen we generate physical or emotional pain from our thoughts or stories.


Challenges for older adults in Pandemicthat contribute to suffering

Ø Having to wait

Ø Lacking purpose

Ø Feeling overwhelmed

Ø Feeling abandoned

Ø Finding no joy in the day

CAREGIVER PAIN/WOUNDED HEALER

TOTAL PAIN

WE ARE THE MEDICINE

PHYSICALSOCIAL

EMOTIONALSPIRITUAL

Cecily Saunders


Total PainClinical Care Research

1. LISTENING TO PATIENT NARRATIVE

“The pain seemed to go away just by talking.”

2. ACKNOWLEDGING A PSYCHO-SPIRITUAL RELATIONSHIP TO PHYSICAL PAIN

3. ACHIEVING A ‘MIDDLE WAY’ BETWEEN TOO MUCH AND TOO LITTLE TREATMENT “Constant pain needs constant control… By providing a more

human understanding of the context of a patient’s distress, the voluntary use of analgesics always decreases.


PAIN WHICH IS NOT

TRANSFORMED

IS ALWAYS TRANSMITTED

Richard Rohr, OFM

Wisd m Insight



Wisd m Insight

If you get rid of the PAIN

before you answer its question, you get rid of

SELF*along with it.

*Self = Psyche = Soul

Carl Jung

Wisdom from our Ancestors

IT IS NECESSARY FIRST TO DIAGNOSE SPIRITUAL PAIN BEFORE ATTEMPTING TO RESPOND TO IT


Monastic Books of the Dying

1 2 3 4 5 6 7 8 9 10

WORST PAIN

NO PAIN

PHYSICAL PAIN SCALEVISUAL ANALOG SCALE


EMOTIONAL PAIN SCALEHAPPY FACE - SAD FACE



SPIRITUAL PAIN SCALE

COMPLETELY GENERAL EXTREME PEACEFUL WELL-BEING ANXIETY

1 2 3 4 5

HOW ARE YOU WITHIN YOURSELF?

“ A person’s spirit will sustain them in sickness, but a crushed spirit who can bear?”

Proverbs 18:14

Filling our days with MeaningThe basic need of the Human Spirit

The Four Dimensions of Spiritual Health

• To find meaning in each day

• To experience forgiveness

• To have connection to what is most important to you

• To have hope in tomorrow

PATTERNS OF SPIRITUAL PAIN

BASED ON SELF EVALUATION OF PATIENTS DURING PASTORAL CARE VISIT

Statistics Based on 500 patient database SALC/RFG

FORGIVENESSHOPE

RELATEDNESS

MEANING


Judgement vs Compassion

“The soul is like a wild animal—tough, resilient, savvy, self-sufficient and yet exceedingly shy. If we want to see a wild animal, the last thing we should do is to go crashing through the woods, shouting for the creature to come out.


FOUR QUALITIES OF SPIRITUAL PAINMEANING

HOPE

RELATEDNESS

FORGIVENESS

JUDGMENT

VS.

COMPASSION


THE ONLY CURE FOR SPIRITUAL SUFFERING IS TO LEAN INTO THE PAIN


Celtic Books of Living & Dying

PRESCRIPTIVE PRACTICES

www.sacredartofliving.org © 2008 Sacred Art of Living Center & InstituteSPIRITUAL — MEDICAL SCIENCE

How are you within today?


WHY AM I HERE?

www.sacredartofliving.org © 2008 Sacred Art of Living Center & Institute

Meaningfulness Makes Us Well

MeaninglessnessMakes Us Sick

“Why am I here?”The question that is asked when meaning is lost.

Ø Lacking purpose

Ø Feeling overwhelmed

Ø Finding no joy in the day

Why do some people want to die?

• Feel that I am a burden to my family

• Feel that everyone will be better off without me

43

Cultural Barriers to finding Meaning

What is really important?

Opportunity to reflect

Finding new purpose – loss gives space for something new –

Discover the role of Being a mentor - my father leading us on how to face death


• Life Review

• Joys and Suffering

• Weekly Option


https://timeslips.org/

Ask a Beautiful Question

Make up a story


RESPONDING TO MEANING PAIN

JOURNALING STORY TELLING

LOGO THERAPY SPIRITUAL GEOGRAPHYING


WHAT DO I NEED TO LET GO OF?


FORGIVENESS THERAPY“Any attempt to access the human capacity for forgiveness is guaranteed to enhance the immune system… thereby enhancing a person’s state of body-mind-spirit balance.”

Joan Borysenko PhD

“Seventy Times Seven”

The 4 Things That Matter Most

Dr. Ira Byock, M.D. is an American physician, author, and advocate for palliative care. He is founder and chief medical officer of the Providence St. Joseph Health Institute for Human Caring in Torrance, California.

The Dying are our teachers about living

“An Elder is one who is closer to the edge of the scared circle of life than you.”


1. “Please forgive me…”

2. “I forgive you…”

www.sacredartofliving.org © 2008 Sacred Art of Living Center & Institute

UNIVERSAL LAW OF FORGIVENESS

“Forgive us our faults… as we forgive those who hurt us.”

The Lord’s Prayer


COMMUNITY

We are not wounded

alone nor do we heal alone…

Monastic Books of Dying

11th century“Caveat quisquis solo vult vivere…”


www.sacredartofliving.org © 2010 Sacred Art of Living

Center for Spiritual Formation

RESPONDING TO FORGIVENESS PAIN

LIFE REVIEW BREATH WORK

12-STEP EXERCISES MEDITATION


WHAT AM I COMMITTED TOIN LIFE AND DEATH?

RELATEDNESS THERAPYSpiritually it is who or what we are in relationship to that which creates a sense of harmony and belonging.

Thich Nhat Hanh

When core relationships, either with persons or things are out of balance, the emotional and physical bodies inevitably become dis-eased.

Thwarted BelongingnessOur need to belong to valued groups and relationships is so powerful that, if frustrated or thwarted, serious negative health consequences follow – including suicide.

The importance of Connection

3. “I love you…”

“What keeps us alive, what allows us to endure?

I think it is the hope of loving, or being loved.”

Meister EckhartLove Poems from God

Connection

Challenges to Connection

• Loss of relationship with those you love

• Loss of identity and role

• Loss of routine and familiar activities

• Loss of connection à leads to experiences of grief

Grief and Mourning

Renew your resources for living


RESPONDING TO RELATEDNESS PAIN

NATURE QUEST RELIGIOUS RITUAL

HEALING ARTSTHERAPEUTIC TOUCH


WHAT DOES THE FUTURE HOLD FOR ME?

Hopelessness…is the terminal illness of spiritual pain.

4. Thank you…

The importance of showing appreciation

“There is more hunger for love and appreciation in this world than for bread.”

Mother Theresa

The important practice of gratitude

Reframing the Darkness

“If the only prayer you say in your whole life is ‘thank you,’ that would suffice.”

Meister Eckhart, a fourteenth-century Christian theologian and mystic

Modeh Ani

“I give thanks”

Observant Jews recite upon waking while still in bed.


RESPONDING TO HOPELESSNESS PAIN

VIGIL PRACTICES

JOURNALINGExpressing GRATITUDE

Meaningful Activity for Long-Term Care Residents With Dementia: A Comparison of Activities and Raters The Gerontologist, Volume 57, Issue 3, 1 June 2017

Ø Improved cognitive functioning Ø Improved mood

Ø Improved life quality Ø Reduced agitation or irritability

Ø Improved person-centered care Ø Improved the general health

Ø Reduced antipsychotics & psychotropic needs

Ø Created a more positive living environment

Impact of Meaningful Activities on Older Adults’ Wellbeing

Providing the right support and the right care, we can help them fill their day with

meaning

Our job as caregivers


Questions?

Thank you for participating

Contact Information

• Rod Harwood, M.Div, MA, QMHP-C , Greater Oregon Behavioral Health [email protected]

Resources

• Sacred Art of Living Center, sacredartofliving.org

• Soul and Science-lessons for caregiver, soulandscience.org• Positive Approach to Care, teepashow.org

• The Four Things that Matter Most, Ira Byock, M.D.

• Oregon Behavioral Health Initiative, oregonbhi.org• TimeSlips - timeslips.org

• Pioneer Network – pioneernetwork.net• Positive Approach to Care – TeepaSnow.com

1 hr. Virtual Trainings available for yousupporting those living with dementia

• Filling the Day with Meaning

• Introduction to GEMS

• 10 Ways to De-escalate a Crisis

• Normal Aging vs. Not Normal Aging

• Challenging Behaviors (Coming Soon)

• Dementia 101 (Coming Soon)

• Connecting Through Music (Coming Soon)

• Brain Changes (Coming Soon)

Sacred Pathways for the Spiritual Restoration

• Naturalist – connecting in nature• Ascetic – being drawn to spiritual disciplines (ie. fasting, solitude)• Traditionalist- loves historical liturgies• Activist- comes alive spiritually in a great cause• Caregiver – meets God in serving• Sensate – senses the divine through five senses• Enthusiast – loves to grow through connection in group activities• Contemplative – is drawn to solitary reflection and prayer• Intellectual – loves the divine by learning, studying sacred

scriptures(Sacred Pathways by Gary Thomas)


DOMINANT FORGIVENESS ISSUES ISSUE

PRESENTING ISSUE REPORTED TO BE RESOLVED

APPARENT LACK OF RESOLUTION

WITH SELF

66% 50% 16%

WITH OTHERS+

17% 15% 2%

WITH GOD

6% 1% 5%

MULTI-LEVEL

11% 3% 8%

+ PERSONS STILL ALIVE: 94%, PERSONS DECEASED: 6%

filling the day with meaning - orh · 2 days ago · oregon’s older adult behavioral health...

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